The Meaning of Balanced Scorecards in the Health Care Organisation

This study investigates the introduction of balanced scorecards in a health care organisation. It analyses a top-down control system, built on measurement, in a medical professional context, where attempts at implementing systematic performance auditing are expected to meet resistance. The study shows, however, that balanced scorecards, redesigned by medical professionals and used in a dialogue about service activities and finances, are regarded attractive successors to criticised financial control systems. In the light of the markets, hierarchies and clans perspective, developed by Ouchi, this popularity becomes comprehensible. Balanced scorecards are seen to reduce both the ambiguity of performance evaluation and the goal in-congruence between parties in the organisation.     

MEASUREMENT AND HEALTH CARE MANAGEMENT

Over recent decades many health care organisations have 'modernised' their management accounting systems by using the balanced scorecard (BSC). However, public health care involves multi-dimensional goals and resolving conflicts of interest. The question is whether a management control system based on measurements is suitable in a health care context. Light can be shed on this question using a study of the application of a BSC over a ten-year period at Högland Hospital. The study shows that the BSC and measurements of output and behaviour became a way of approaching unanswered questions about processes and quality development. Medical professionals with management responsibility, in co-operation with medical professionals responsible for different specialities, determined measures and targets and the measurements were integrated into activity processes and affected activities.